FW: Lack of time, knowledge or just sloppy thinking?

Lorri Zipperer Lorri at ZPM1.COM
Wed May 1 15:56:50 UTC 2013


From: pb [mailto:mikburger22 at yahoo.com] 
Sent: Wednesday, May 01, 2013 9:19 AM
To: Society to Improve Diagnosis in Medicine; Alan Morris
Subject: Re: Lack of time, knowledge or just sloppy thinking?

 


 

 

This is where the work of Sydney Dekker is so important.

 

http://www4.lu.se/o.o.i.s/6102

 

Likewise, the work of Dan Ariely dovetails with these issues.

 

http://web.mit.edu/ariely/www/MIT/papers.shtml

 

Paul

 



--- On Wed, 5/1/13, Alan Morris <Alan.Morris at IMAIL.ORG> wrote:


From: Alan Morris <Alan.Morris at IMAIL.ORG>
Subject: Re: Lack of time, knowledge or just sloppy thinking?
To: IMPROVEDX at LIST.IMPROVEDIAGNOSIS.ORG
Date: Wednesday, May 1, 2013, 9:07 AM

If we did this to pilots, no one would fly.

Paradoxically, we have tools to address this – but virtually no support of interest from funding agencies to pursue development.

Have  a nice day.

 

Alan H. Morris, M.D.

 

 

From: "Dr.Will" <dr.will at fuse.net <http://us.mc1200.mail.yahoo.com/mc/compose?to=dr.will@fuse.net> >
Date: Wednesday, May 1, 2013 7:54 AM
To: 'Society to Improve Diagnosis in Medicine' <IMPROVEDX at LIST.IMPROVEDIAGNOSIS.ORG <http://us.mc1200.mail.yahoo.com/mc/compose?to=IMPROVEDX@LIST.IMPROVEDIAGNOSIS.ORG> >, "Alan H. Morris, MD" <alan.morris at imail.org <http://us.mc1200.mail.yahoo.com/mc/compose?to=alan.morris@imail.org> >
Subject: RE: Lack of time, knowledge or just sloppy thinking?

 

Yes and EMR data entry requirements have exceeded human capability to provide good clinical care (and both eyes and physical contact on patient) in the compressed time allotment by insurance payment and hospital owned productivity requirements. No wonder there are errors in DX and Outcomes.

If we did this to pilots, there would be more errors, as well. My brother is a retired pilot.

Will Sawyer, MD

 

  _____  

From: Alan Morris [mailto:Alan.Morris at IMAIL.ORG <http://us.mc1200.mail.yahoo.com/mc/compose?to=Alan.Morris@IMAIL.ORG> ] 
Sent: Wednesday, May 01, 2013 9:26 AM
To: IMPROVEDX at LIST.IMPROVEDIAGNOSIS.ORG <http://us.mc1200.mail.yahoo.com/mc/compose?to=IMPROVEDX@LIST.IMPROVEDIAGNOSIS.ORG> 
Subject: Re: Lack of time, knowledge or just sloppy thinking?

 

My assessment is that human think is "sloppy",  by which I mean more attuned to system 1 than system 2 cogitation (re Khanneman, Thinking Fast and Slow).  This is why, I believe, pilots and the FAA have for so long relied on checklists.  It reflects their implicit appreciation of human thought limitations.

Have  a nice day.

 

Alan H. Morris, M.D.

Professor of Medicine

Adjunct Prof. of Medical Informatics

University of Utah

 

Director of Research

Director Urban Central Region Blood Gas and Pulmonary Laboratories

Pulmonary/Critical Care Division

Sorenson Heart & Lung Center - 6th Floor

Intermountain Medical Center

5121 South Cottonwood Street

Murray, Utah    84157-7000 , USA

 

Office Phone: 801-507-4603

Mobile Phone: 801-718-1283

Fax: 801-507-4699

e-mail: alan.morris at imail.org <http://us.mc1200.mail.yahoo.com/mc/compose?to=alan.morris@imail.org> 

e-mail: alanhmorris at gmail.com <http://us.mc1200.mail.yahoo.com/mc/compose?to=alanhmorris@gmail.com> 

 

From: Jason Maude <Jason.Maude at ISABELHEALTHCARE.COM <http://us.mc1200.mail.yahoo.com/mc/compose?to=Jason.Maude@ISABELHEALTHCARE.COM> >
Reply-To: Society to Improve Diagnosis in Medicine <IMPROVEDX at LIST.IMPROVEDIAGNOSIS.ORG <http://us.mc1200.mail.yahoo.com/mc/compose?to=IMPROVEDX@LIST.IMPROVEDIAGNOSIS.ORG> >, Jason Maude <Jason.Maude at ISABELHEALTHCARE.COM <http://us.mc1200.mail.yahoo.com/mc/compose?to=Jason.Maude@ISABELHEALTHCARE.COM> >
Date: Wednesday, May 1, 2013 5:22 AM
To: "IMPROVEDX at LIST.IMPROVEDIAGNOSIS.ORG <http://us.mc1200.mail.yahoo.com/mc/compose?to=IMPROVEDX@LIST.IMPROVEDIAGNOSIS.ORG> " <IMPROVEDX at LIST.IMPROVEDIAGNOSIS.ORG <http://us.mc1200.mail.yahoo.com/mc/compose?to=IMPROVEDX@LIST.IMPROVEDIAGNOSIS.ORG> >
Subject: Re: Lack of time, knowledge or just sloppy thinking?

 As another research focus, I think it would be useful to try and look at dx decision errors and analyse whether they were due to lack of time, lack of knowledge or just sloppy thinking. This again would have a big influence on possible solutions.

 I experienced my own, minor, misdiagnosis a few weeks ago which I recounted in a blog: http://info.isabelhealthcare.com/blog/bid/177313/Differential-diagnosis-the-crucial-trigger-for-thinking-better

 In short, I damaged my hand and got an initial diagnosis (from my GP) of a fractured 4th metacarpal which was confirmed on x-ray. A routine review of the x-ray 2 days later (by a senior radiologist) showed that I had also dislocated my 5th carpometacarpal joint which was much more serious and needed an immediate operation. Hopefully there will be no long term damage. The ortho that carried out the operation said that the dislocation "stuck out like a sore thumb" on the x-ray!

 None of the clinicians I saw was rushed so this simple mistake couldn't have been due to lack of time and I concluded was either due to lack of knowledge or, more likely, sloppy thinking.

 Were Rob's errors below due to lack of time or sloppy thinking? If time was not the issue then the solution has to be a practical trigger to step back and think more methodically. At what point does lack of time move from being a reasonable explanation to just an excuse for sloppy thinking? 

 Jason Maude

Founder and CEO Isabel Healthcare
Tel: +44 1428 644886
Tel: +1 703 879 1890
www.isabelhealthcare.com <http://www.isabelhealthcare.com/> 

 

 

 

 









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